Dear Doctor
I have this rash for several months and it’s only getting worse. It’s spreading all around my neck all the way to my other shoulder. I was wondering if it could be related to the fatigue I’ve been having.
Dear Patient
The lesions on your picture are not very clear and so I cannot give you a definitive answer. I suggest that you send us another focused photo.
In the meantime I will discuss the conditions that can cause a skin rash and fatigue.
Rash and Fatigue
Conditions which can cause a skin rash and fatigue or exhaustion include:
Pityriasis Rosea
The cause of Pityriasis rosea is not known but some scientists suspected it is caused by a virus and it has been linked to the human herpesvirus 7. Pityriasis rosea begins as a single, oval lesion known as the herald patch. This lesion which is usually located on the trunk, has a pink, wrinkled area which is separated from the red periphery by fine scales. It usually measures between 2 and 10 cm. After around 1-2 weeks the large herald patch is replaced by smaller, symmetrical daughter lesions which are pink in color and measure around 5-10 mm and a circumferential collarette scaling with central clearing. They usually develop on the trunk, neck and limbs. In some patients the pityriasis rosea rash can be preceded by flu-like symptoms which include exhaustion, fever, anorexia (loss of appetite), headache and body aches.
Lyme Disease
Lyme disease is caused by the bacterium Borrelia burgdorferi and it is transmitted to humans through the bites of infected blacklegged ticks. Symptoms of lyme disease include fatigue, fever, headache and a skin rash known as erthyema migrans. This lyme skin rash, which is also known as erythema chronicum migrans, is characterized by an annular and erythematous (round and red) lesion which expands by radiating from the site of the original tick bite. It often has central sparing which gives it a target-like appearance (bull’s eye rash).
Infectious Mononucleosis
Infectious mononucleosis, which is also known as glandular fever or mono, is caused by the human herpes virus type 4 which is also known as the Epstein Barr virus (EBV). This virus is transmitted to humans through saliva for example by kissing or sharing cups. Symptoms of infectious mononucleosis include fatigue, fever, sore throat, muscle aches and enlarged lymph nodes (glands). A skin rash also develops in around 10% of patients with infectious mononucleosis due to the virus. This rash is a maculopapular exanthema (red, flat patches with some swellings) and it develops on the trunk and arms before spreading to the face and forearms. Patients with infectious mononucleosis who take antibiotics like ampicillin, amoxicillin and cephalosporins can also develop a rash due to hypersensitivity reaction to the medication. This rash is morbilliform (measles-like) and it develops on the extensor surfaces and pressure points 7-10 days after taking the antibiotics.
Chickenpox
Chickenpox, which is also known as varicella, is caused by the varicella zoster virus (VZV). It is transmitted by airborne droplets from person to person to through contact with infected items like clothing. The chickenpox rash is characterized by crops for red, itchy macules (small flat areas) which evolve into papules (small swellings) and vesicles (fluid filled swellings) with a “dewdrop on a rose petal” appearance. It mostly affects the trunk though it can develop on any part of the body. The chickenpox rash can be preceded by fever, fatigue, headache and muscle aches.
Drug Adverse Effects
Some medications can cause a skin rash and fatigue as their side effects.
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